An ingrown toenail (Onychocryptosis) occurs when the edge of the nail plate penetrates the surrounding soft skin of the toe, usually the big toe. This causes inflammation, redness, and significant pain, often leading to infection if untreated. Simply removing the offending piece of nail does not guarantee a permanent solution. The toenail often grows back to become ingrown again if the underlying causes for its abnormal growth pattern are not permanently addressed.
Why Ingrown Toenails Recur
The tendency for an ingrown toenail to return often stems from a combination of external pressures and intrinsic factors related to the foot itself. A very common external cause is improper trimming technique. Cutting the nails too short or rounding the corners, instead of clipping straight across, leaves a small, sharp spicule primed to grow directly into the flesh of the nail fold. This action can create a pathway for bacteria to enter the soft tissue, leading to an inflammatory response and infection.
Another major contributing factor is the constant, chronic external pressure, most often from footwear. Shoes that are too tight, too narrow in the toe box, or high heels that push the foot forward repeatedly compress the nail against the skin. This pressure prevents the nail from growing naturally forward and encourages the sides to curl into the soft tissue. Even in cases where the ingrown portion is successfully removed, continuing to wear ill-fitting shoes will almost certainly cause the nail to recur.
The intrinsic factors relate to the structure of the foot and nail itself, which are not altered by simple nail removal. Some people are genetically predisposed to have toenails that are naturally fan-shaped or excessively curved, making them more likely to press into the skin as they grow. This inherited nail morphology, sometimes called a pincer nail, creates a constant structural issue that cannot be solved by temporary measures. The recurrence rate is high because the shape of the nail plate and the nail bed from which it grows remain the same after a simple trimming or partial removal.
Conservative Methods for Long-Term Prevention
Implementing proper nail care techniques is the first and most effective conservative measure against recurrence. Toenails should always be cut straight across, taking care to never cut them shorter than the edge of the toe. The corners should not be rounded down or tapered, as this is precisely what encourages the remaining nail edge to grow inward. It is also important to use clean, sharp trimmers to avoid splintering the nail.
Footwear must be selected with preventative care in mind to eliminate external pressure on the toes. Choosing shoes with a wide, deep toe box ensures that the forefoot and toes have enough space to move freely. Avoiding pointed-toe shoes and high heels, which force the toes together, can significantly reduce the risk of inward nail growth. This practice is especially important for individuals who spend long hours standing or engaging in sports where the feet are under repetitive stress.
Daily foot hygiene and careful inspection are also important components of prevention. Keeping the feet clean and dry reduces the risk of fungal infections, which can change the texture and thickness of the nail plate, making it more prone to ingrowth. For minor cases, gently lifting the nail edge and placing a small piece of cotton or dental floss underneath can help redirect the nail to grow over the skin instead of into it. This technique must only be performed if there is no sign of infection, and the material needs to be replaced daily after soaking the foot.
Medical Interventions for Permanent Resolution
When conservative methods fail, or for cases that are chronic and recurring, a medical intervention targeting the nail’s growth source is necessary for permanent resolution. The standard procedure for long-term correction is a Partial Nail Avulsion (PNA) combined with a matrixectomy. During a PNA, the physician numbs the toe and removes only the small, ingrown section of the nail plate, leaving the remaining healthy nail plate intact.
The critical step for preventing regrowth is the matrixectomy, which involves chemically or surgically destroying the portion of the nail matrix responsible for the ingrown segment. A chemical matrixectomy typically uses a compound like phenol or sodium hydroxide, which is applied to the exposed nail bed after the ingrown nail section is removed. This chemical application ablates the nail-producing cells at the corner of the nail root. The goal is to permanently narrow the nail, ensuring that the entire nail plate is narrower than the toe bed.
Surgical matrixectomy, less common but sometimes necessary, involves physically removing the small strip of tissue that forms the nail matrix. Both chemical and surgical methods are highly effective, with success rates often exceeding 90% in preventing recurrence in the treated segment. Following the procedure, the toe will require a period of rest and elevation for 12 to 24 hours, with full healing typically occurring within a few weeks. The removed section of the nail will not regrow, thus providing a definitive, long-term solution to the recurring problem.